Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures

Watson, Adam; Zhang, Yu; Beattie, Sally; Page, Richard

doi:10.1111/j.1445-2197.2012.06256.x

Cited by 37 publications

(46 citation statements)

References 13 publications

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“…19 An updated pooled analysis of reoperation including small trials with our FAITH results (eight trials, 1913 patients) reported a 95% CI that was narrower than our study’s but was still consistent, with no difference between fixation methods (0.91, 0.76–1.08; p=0.27, I 2 =7%). 25–31 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Nauth¹,

Creek²,

Zellar³

et al. 2017

The Lancet

237

104

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Summary Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0.83, 95% CI 0.63–1.09; p=0.18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1.91, 1.06–3.44; p=0.0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0.82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0.41) and sepsis (seven [1%] vs six [1%]; p=0.79). Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. Funding National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians’ Services Incorporated.

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Section: Discussionmentioning

confidence: 99%

“…The addition of another small trial to a previous meta-analysis results in a significant reduction in the risk of avascular necrosis with sliding hip screws (77 events; relative risk 0.64, 95% CI 0.43–0.97; p=0.04, I 2 =0%). 19,25 …”

Section: Discussionmentioning

confidence: 99%

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Nauth¹,

Creek²,

Zellar³

et al. 2017

The Lancet

237

104

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“…Outcomes after cancellous screw fixation are highly dependent on surgical expertise and the quality of the reduction [6]. Recently we have used two different cannulated compression titanium screws (full threaded versus partial threaded) in the surgical treatment of the adult femoral neck fractures.…”

Section: Introductionmentioning

confidence: 99%

“…Techniques range from internal fixation with multiple cancellous lag screws and sliding hip screws for nondisplaced fractures to multiple cancellous lag screws, sliding hip screws, hemiarthroplasty, and total hip replacement for displaced femoral neck fractures [5][6][7][8]. Options for internal fixation have included a variety of implants [9,10], however most recent reports and textbooks cite parallel multiple cancellous screws as the surgical technique of choice [6][7][8][11][12][13]. Potential advantages of multiple screws over arthroplasty include short duration of surgery, limited surgical trauma and preservation of the native hip joint [7,8].…”

Section: Introductionmentioning

confidence: 99%

Should full threaded compression screws be used in adult femoral neck fractures?

Okçu

Özkayın

Erkan

et al. 2015

Injury

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“…However, this was not observed in the present cohort with a previous study similarly demonstrating TAD was independent of femoral neck-shaft angle when using a 135 DHS in 144 hip fractures. 11 The questionnaire revealed that whilst most concepts related to correct lag screw placement were well understood (correct responses in 81% or more for questions [1][2][3][4][5], the common deficiency in knowledge amongst almost half of surgeons related to how to measure TAD (correct responses in 57% for question 6). Correct responses to all questions were independent of surgeon grade and procedural experience apart from question 3 ( Table 5) which demonstrated that surgeons performing more DHS procedures were significantly more likely to correctly identify the ideal lag screw position in the femoral head on the anteroposterior radiographic view.…”

Section: Discussionmentioning

confidence: 99%

Accuracy and awareness of lag screw placement when using the dynamic hip screw for fracture fixation

Matharu

Shahid

Pynsent

et al. 2014

Trauma

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Introduction: Correct lag screw placement in the femoral head is important to prevent screw cut-out following dynamic hip screw (DHS) fracture fixation. The aim of the study was to determine the accuracy and awareness of lag screw placement when using the DHS for fracture fixation. Patients and methods: A retrospective radiographic review of 238 DHS procedures (mean age 81.1 years; 76% female) performed at one centre was undertaken to determine the proportion of lag screws placed correctly (tip-apex distance (TAD) less than 25 mm and central femoral head lag screw position in both radiographic views). A questionnaire was also distributed to 102 orthopaedic surgeons to assess awareness of correct lag screw placement. Results: Mean TAD for 238 procedures was 17.2 mm with specialist registrars performing 74%. Lag screws were correctly placed in 80% (n ¼ 190) with correct placement independent of surgeon grade (p ¼ 0.418), AO fracture classification (p ¼ 0.306) and contralateral femoral neck-shaft angle (p ¼ 0.748). This remained unchanged when 17 lag screws meeting the recommendations, but with an inferior position on the anteroposterior radiograph, were included as correctly placed. Surgeons correctly defined TAD, stated the recommended TAD and measured TAD correctly in 81%, 81% and 57%, respectively. Correct responses were independent of surgeon grade and number of procedures performed. Conclusions: Although most lag screws were placed correctly, the questionnaire revealed that almost half of surgeons measured TAD incorrectly. Educating surgeons on the concepts related to correct lag screw placement and acquiring technical skills using surgical simulators may reduce the risk of screw cut-out in their practice.

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Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures

Cited by 37 publications

References 13 publications

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Should full threaded compression screws be used in adult femoral neck fractures?

Accuracy and awareness of lag screw placement when using the dynamic hip screw for fracture fixation

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